POTENTIAL RISK FACORS FOR LOW IMMUNIZATION COVERAGE IN AGHANISTN.

More than 500,000 under one year aged children are in risk of vaccine preventable diseases due to no vaccination or incomplete status of their immunization. According to the Afghanistan DHS survey 13 percent of children have never received any immunization and full immunization coverage among children under one year is 46%. Understanding the potential risk factor for low immunization coverage is necessary to find the gaps. This reasrch aiming to know the key and fundamental challenges affecting EPI system of leadership, management and governance. Method: A qualitative study is conducted in five provinces of Afghanistan and focused group discussion(FGD) method used to determine leadership, management and governance gaps among the EPI management teams. key officers attended each FDG and five FDG session was conducted. This group of 30 officers are representing 20% of the total current EPI managers. Time Frame: This study took 10 weeks from the start to preparation of this first report. Results: EPI Managers compliance with leading, Managing and Governing of EPI program is ranging from 50-60%. Hot problematic issues remain as chronic problem. Government salary scale is very low and does not attract qualified people, Higher dependency on consultants in all provinces, low motivated staff. Poor EPI planning and monitoring at sub-national levels. Security affected monitoring of services in remote areas. Politically negative communication on use of vaccine reduced the level of acceptance of services by the families. National financial analysis indicates about 30% gaps in resources for EPI program and indicates higher dependency on donors funding. Recommendations: Improve HR management, improve monitoring and supervision at all level. Improve standardization in planning. EPI communication to match the knowledge gaps at the families. More training opportunities to EPI managers, Government to explore the possibilities of better resource allocation for EPI and to plan for EPI sustainability.